Friday, December 5, 2008

Europe’s turn to waste money

The Health IT Nerd has spies all over Europe, so I got showered with notifications when a new report was released by the EU last week.

These reports are nothing new. Governments need to commission these reports every so often, to make sure that they’re not on track in their programs. And it doesn’t matter which government, it always works the same way. The government announces it wants a report, and invites all and sundry to bid to do it (usually this is called and RFP or something similar). Then the government ranks the bids, and either picks the one it was going to pick anyway, or chooses the cheapest, from the dumbest least informed clown that bothered to respond.

If it was a pre-selected winner, then, surprise: the report spins things how the government wants. Or, if it’s the cheapest respondent, then the report might say anything at all. If it’s sufficiently crap, the government throws it to the wolves (whoops, I mean the relevant industry), and everyone feels better for having canned the crap that the government needed canned anyway.

This happens everywhere in every industry. I think it gets taught in Government 101. But everyone plays the game dutifully, because you never know quite which variant of the game is on until later. Hindsight is 20/20 (or maybe just 20/10 or something).

In spite of that, I’ll bet all the monopoly money I can find in my hovel that this one is being thrown to the wolves. One thing you can be sure of: it’s utter crap. Check the extensive and thorough preparations undertaken to prepare this report:

In November 2007, empirica conducted an online survey of e-health experts from ICT industry, user organisations, public authorities, university and research, SDOs, and consultants. 94 experts responded

94 experts? Wow, that’s thorough. For all we know, 90 of them were French, and the French don’t know anything about anything. Also, it lists OpenEHR as a standards organization. Now while the openEHR guys seem to be trying to do something useful, they ain’t no standards group (actually, I think I'll make a report of my own about them in the future). 

If I hadn’t already had turkey for thanksgiving, this report would’ve done nicely for a late consolation prize.

So, let’s see what their extensive research yields in terms of conclusions:

Current situation in e-health standards: Nearly all interviewees agreed that there is a lack of widely used e-health standards.

There’s a lack of widely used e-health standards? Have they not heard of HL7? Or perhaps “widely” has a different meaning in Europe? So maybe the respondents were French after all.

Impacts of current situation: Nearly three quarters of the respondents indicated that within a single health service provider the overall situation is supportive, but the majority found the situation unsupportive for cross-border care provision.

Well, the outcome certainly wasn’t the ability to write meaningful sentences (this might demonstrate that they understand the essentials of interoperability properly after all). 

Barriers to adopt common e-health standards in hospitals: Hospital IT managers may first of all find internal process functionality more important than commonly used standards.
Well, duh. That’s exactly the real problem (maybe I did respond to this survey after all). Everyone in the industry is in the same boat: my process functionality is more important than commonly used standards, and I’m not going to waste money on them. 

Hang on: “waste money on standards”?

Isn’t the whole point of standards that they save money? Well, yes. And no. Rather more no than yes, unfortunately, in the healthcare industry. If everyone adopts standards over the industry as a whole, then they will pay off. But only if everyone does. It’s a two-edged sword.

For vendors, in the absence of standards, they get paid to do the same work again and again – nice safe money. But that sucks. No one enjoys it, and it’s damn hard to hold on to staff as it is without making them do the same thing again and again. For care providers, adopting standards might offer the ability to purchase cheaper software, but it also means behaving in a standard fashion. Where’s the business ego differentiator in that?

If you look across other industries, and see which ones have rapidly adopted standards, it’s the ones where the adoption of standards has drastically increased the size of the whole pie, so everyone benefits. But in health, the pie is already as big as it can get. So the result of using standards is just to reallocate parts of the pie.

It’s not for lack of trying, but the governments can’t impose proper standards on the industry, because the industry just doesn’t want them across the board. It’d rather adopt them in a piece meal fashion – the patient will pay, one way or another.

And how can healthcare get away with this? Politics. It’s always politics. See, doctors have unbelievable power in society, and they’re tremendously conservative when it comes to how things are done. Sure, that’s got it’s bad side, but hands up anyone who wants to volunteer to be the guinea pig for a new way of doing things. And everyone, even El Presidente or whatever they’re calling themselves this year, eventually everyone is going to be a patient.

Anyhow, back to the report. It seems to me that they demonstrate a complete knowledge of the current state of the industry when they say:

In January 2008, the US Department of Health and Human Services recognised certain interoperability standards for health ICT which federal agencies have to include in procurement specifications for certain fields of health. This could be a step towards mandatory use of a confined number of standards for principal e-health applications. Such a regulation by the US government could have considerable impacts in the EU. In order to prevent unfavourable developments, the EC and the Member States may be well advised to develop a common strategy and roadmap for e-health standards development.

Let’s see if I understand this correctly: USA did something, so in response, the EC and it’s member states better go and do their own thing. 

Interoperability: it’s all about the people. And it doesn’t look like there’ll be any change soon.


Unknown said...

Well, you are correct that the openEHR group is not an official standards organization. I will however (in my biased opinion) say that it is well governed.

The report that you mention goes on to cluelessly explain openEHR as a software development organization which show a COMPLETE lack of investigation.

I actually know some of the authors and was very disappointed with the quality of the report. It seems that academics just need to PUBLISH something in order to maintain their career. How sad that this is the case.

Anonymous said...

Thanks. openEHR is something I will comment on soon.

As for academics - what do you do if you don't know enough to get paid for putting your knowledge to good use? You get paid for just having knowledge. Magic. Man, I've got to get me a piece of that action.

Unknown said...

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Look, this blog isn't supposed to be about healthcare politics. It's supposed to be about healthcare IT. But the intersection betwee...